EFM Question

SmilingBluEyes · Oct 1, 2003

Ah, well that sure depends on what is on the strip. And each mom/baby case is unique and must be taken into account!

Personally, I always look for good reactivity and reassuring patterns, over at least 20-30 minutes before taking a mom off the monitor to ambulate or shutting it off for any reason.

If there are decelerations, I watch it longer, looking for reassuring components and good variability. I observe to ensure the strip does not show signs of worsening or becoming ominous.

Risk factors must be taken into account, also. If you are dealing with a high-risk pregnancy, such as oligo, PIH, IDDM, IUGR, known fetal anomalies, etc, it is prudent to keep a very close watch on the monitor and frequently. But again, nothing less than about 30 minutes will draw a true picture for me, if reassuring. If not, or variability is low, I will watch longer, until I see increased variability or improvements, again, at least 30 minutes or so of reassuring patterns.

I look for AT LEAST 3 accelerations in 20 minutes, using the 15x15 rule (15 bpm over baseline over at least 15 seconds in duration).

There should be established protocols in your hospital regarding fetal heart monitoring, Non-stress testing, etc. You may want to review them some!

Hope this helps.

babynurse32 · Oct 2, 2003

We do have certain criteria fro reassuring Vs. Not. i am wondering if you are charting a fetal heart every 15 minutes on our flow sheet, and you are now at 1400, how much of the strip do you look at to document for that time slot. Example, do you go from the 1400 marking and look at what happened the 15 mintues previous, or do you wait until some of the strip has run through after 1400 and write according to what has shown up previous to and after?

bagladyrn, RN · Oct 2, 2003

If I'm charting routinely I take into account the strip from the previous time of charting. As in the above post, if charting at 1415, I consider the strip from my previous charting at 1400 up til 1415, etc.

LuvsOB · Oct 2, 2003

Same as bagladyrn. If it's 0400 and I last charted at 0345, I look at the 15 minutes between the two and then chart that in the 0400 time slot. When I first hook them up I indicate EFM is on but I don't begin charting what it is until 15 minutes later.

mother/babyRN, RN · Oct 2, 2003

In my previous job, we had central monitoring and whenever the mom was on the monitor we had to chart every 15 minutes whatever the circumstance ( a real pain for a non interventive plan)....Even if you simply marked, strip reviewed...Prior to central monitoring, I got into the habit of documention things on the strip as I was doing them so I could catch up on notes and times later on. That has proved invaluable in my current position, as there is no central monitoring and we are always trying to catch up on paper work, or determine exactly when what happened. I am with SmilinBlueyes in many of the parameters she mentioned. Can't be too careful......